Abstract
Purpose of Review
The approval of resmetirom brings great hope to patients with metabolic dysfunction-associated steatohepatitis (MASH). The purpose of this review is to explore its impact on the global health environment. The implementation of multidisciplinary management MASH is proposed.
Recent Findings
Resmetirom has benefits in the treatment of MASH, and its safety and effectiveness have been studied. The adverse events (AEs) need to be noticed. To improve patient outcomes, a multimodal approach with medication such as resmetirom, combined with metabolic and bariatric surgery (MBS) and lifestyle interventions can be conducted.
Summary
MASH, a liver disease linked with obesity, is a challenging global healthcare burden compounded by the absence of any approved pharmacotherapy. The recent conditional approval by the Food and Drug Administration (FDA) in the United States of resmetirom, an oral, liver-directed, thyroid hormone receptor beta-selective agonist, marks a significant milestone, offering a treatment option for adults with non-cirrhotic MASH and who have moderate to advanced liver fibrosis. This narrative review discusses the efficacy and safety of resmetirom and its role in the therapeutic landscape of MASH treatment. Despite the promising hepatoprotective effect of resmetirom on histological liver endpoints, its use need further research, particularly regarding ethnic differences, effectiveness and cost-effectiveness, production scalability, social acceptance and accessibility. In addition, integrating resmetirom with other multidisciplinary therapeutic approaches, including lifestyle changes and MBS, might further improve clinical liver-related and cardiometabolic outcomes of individuals with MASH. This review highlights the importance of a comprehensive treatment strategy, supporting continued innovation and collaborative research to refine treatment guidelines and consensus for managing MASH, thereby improving clinical patient outcomes in the growing global epidemic of MASH. Studies done to date have been relatively short and ongoing, the course of the disease is highly variable, the conditions of various patients vary, and given this complex clinical phenotype, it may take many years of clinical trials to show long-term benefits.
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Data Availability
No datasets were generated or analysed during the current study.
Change history
26 August 2024
Author's name should be "Panagiotis Lainas" in xml.
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Acknowledgements
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Global Obesity Collaborative
Kahei Au, Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China; Ming-Hua Zheng, MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China; Wei-Jei Lee, Medical Weight Loss Center, China Medical University Shinchu Hospital, Zhubei City, Taiwan, China; Omar M Ghanem, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA; Kamal Mahawar, Department of Upper Gastrointestinal Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK; Asim Shabbir, National University of Singapore, Singapore; Carel W le Roux, Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland; Giovanni Targher, Department of Medicine, University of Verona, Verona, Italy, Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Italy; Christopher D. Byrne, Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton, and University of Southampton, Southampton General Hospital, Southampton, UK; Yusuf Yilmaz, Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey; Luca Valenti, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, Precision Medicine, Biological Resource Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy; Giada Sebastiani, Division of Gastroenterology and Hepatology, Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada; Sombat Treeprasertsuk, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Hannah Xiaoyan Hui, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Nasser Sakran, Department of General Surgery, Holy Family Hospital, Nazareth, Israel, The Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel; Manoel Galvao Neto, Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando, USA, Mohak Bariatric and Robotic Center, Indore, India; Mohammad Kermansaravi, Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Hazrat-e Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Lilian Kow, Department GI Surgery, Flinders University South Australia, Adelaide, Australia; Yosuke Seki, Weight Loss and Metabolic Surgery Centre, Yotsuya Medical Cube, Tokyo, Japan; Kwang Wei Tham, Endocrinology Services, Department of Medicine, Woodlands Health, National Healthcare Group, Singapore; Jerry Dang, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States; Ricardo V Cohen, The Center for Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil; Christine Stier, Department of MBS and bariatric endoscopy, University hospital Mannheim, Heidelberg University, Mannheim, Baden-Wuerttenberg, Germany; Salman AlSabah, Department of Surgery, Kuwait University, Kuwait, Kuwait; Rodolfo J Oviedo, Nacogdoches Medical Center, Nacogdoches, Texas, USA, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA, Sam Houston State University College of Osteopathic Medicine, Conroe, Texas, USA; Sonja Chiappetta, Bariatric and Metabolic Surgery Unit, Department for General and Laparoscopic Surgery, Ospedale Evangelico Betania, Naples, Naples, Italy; Chetan Parmar, Department of Surgery, 1. Whittington Hospital 2. University College London, London, London, United Kingdom; Wah Yang, Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China; Tamer Nabil Abdelbaki, HPB Surgery, Alexandria University Faculty of Medicine, Alexandria, Alexandria, Egypt; Mohamed Abouelazayem, Department of General Surgery, University College London Hospitals, London, London, United Kingdom; Adel Karim Abou-Mrad, Viceral and digestive surgery, Centre Hospitalier regional et Universitaire d'Orleans, Orleans, Loiret, France; Adam Abu-Abeid, Division of General Surgery, Bariatric Surgery Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, Israel; Suhaib Ahmad, General Surgery, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK; Hazem Al-Momani, Weight Management Unit, Royal NMC Hospital, Abu Dhabi, Abu Dhabi, United Arab Emirates; Bassem Amr, Upper GI and Bariatric surgery, County Durham and Darlington NHS Foundation Trust, Durham, Durham, UK; Rahmatullah athar, General Surgery, Iran University of Medical Science, Tehran, Tehran, Iran; Selmy S Awad, Department of General Surgery, Mansoura University Hospital, Mansoura, Dakahlia, Egypt; Muhammed Rasid Aykota, Department of General Surgery, Tekden Hospitals, Denizli, Denizli, Turkey; Ali Haider Bangash, Department of Surgery, Shifa International Hospital, Islamabad, Islamabad Capital Territory, Pakistan; Ruth Blackham, Department of Surgery, The University of Western Australia, Perth, WA, Australia; Ismail Calikoglu, Metabolic and Bariatric Surgery, Calikoglu Bariatrics, Istanbul, Istanbul/Sisli, Turkey; Patricia Yoshimia Castillo Vacaflor, Nutricion Bariatrica, Centro Medico Foianini, Santa Cruz de la Sierra, Santa Cruz, Bolivia; Suleyman Cetinkunar, Department of General Surgery, Adana City Training and Research Hospital (Affiliated to Health Science University Adana Medical Faculty), Adana, Adana, Turkiye; Jin Chai, Department of Gastroenterology, Institute of Digestive Diseases of PLA, Cholestatic Liver Diseases Center and Center for Metabolic Dysfunction-Associated Fatty Liver Disease, The First Affiliated Hospital (Southwest Hospital), Third Military Medical University (Army Medical University), Chongqing, Chongqing, China; Tao Chen, Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China; An-Tian Chen, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, Beijing, China; Andre Costa-Pinho, Obesity Integrated Responsibility Unit, Sao Joao University Medical Center, Porto, Porto, Portugal; Anna Carolina Batista Dantas, Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Nadia De Falco, Bariatric and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Naples, Italy; Viorel Dejeu, Metabolic and Bariatric Surgery, MedLife Romanoa, Bucharest, Bucharest, Romania; Tugrul Demirel, Department of General Surgery, Trakya University, Edirne, Edirne, Turkiye; Yi Duan, Department of Infectious Diseases, The First Affiliated Hospital of USTC, Department of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Mohamad Hayssam Elfawal, MBS Department, Makassed General Hospital, Beirut, Beirut, Lebanon; Hosam M Elghadban, Department of Surgery, Mansoura University, Elmansoura city, Eldakahlia, Egypt; Mostafa Refaie Elkeleny, Department of GIT and Liver Surgery, Alexandria University Hospital, Alexandria, Alexandria, Egypt; Yu-Chen Fan, Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China; Tingyu Fang, Department of Infectious Diseases, The First Affiliated Hospital of USTC, Department of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Daniel Moritz Felsenreich, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Vienna, Austria; Jose Eduardo Garcia Flores, Metabolic and Bariatric Surgery, Christus Muguerza/UDEM, Monterrey, Nuevo Leon, Mexico; Khaled Aly Gawdat, Bariatric Surgery, Ain Shams University Faculty of Medicine, Abbasya, Cairo, Egypt; Omar Ghazouani, Department of Surgery, Santa Corona Hospital, Pietra Ligure, Savona, Italy; Li Hai, Department of Gastroenterology and Hepatology, Tianjin Xiqing Hospital, Tianjin, Tianjin, China; Juqiang Han, Department of Day Treatment, The Seventh Medical Center of PLA Hospital, Beijing, Beijing, China; Yingli Hee, Department of Infectious Diseases, The first affilated hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Anna Carolina Hoff, Advanced Interventional Endoscopy, Angioskope, Sao paulo, Sao paulo, Brazil; Songhao Hu, Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, GuangZhou, Guangdong, China; Ang Huang, Department of Gastroenterology and Hepatology, The First Medical Center of PLA General Hospital, Beijing, Beijing, China; Sara Ingallinella, Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy, Italy; Richa Jaiswal, Dietetics, Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India; Fanpu Ji, Department of Infectious Diseases, Second Affiliated Hospital Xi'an Jiaotong University, Xi'an, Shaanxi, China; Abd-Elfattah Morsi Kalmoush, General Surgery, Al-Azhar University, Cairo, Bab elsharia, Egypt; Nik Ritza Kosai, Upper Gi, Bariatric &Metabolic Surgery, Universiti Kebangsaan Malaysia ( National University Of Malaysia), Kuala Lumpur, Wilayah Persekutuan, Malaysia; Panagiotis Lainas, Department of Metabolic and Bariatric Surgery, Metropolitan Hospital, Athens, Attica, Greece; Muffazal Lakdawala, Department of General Surgery and Minimal Access Surgical Sciences, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India; Yaming Liu, Department of Gastroenterology and Hepatology, Xiamen University Zhongshan Hospital, Xiamen, Fujian Province, China; Skye Marshall, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia; Pedro R Martinez-Duartez, Department of Metabolic and Bariatric Surgery, Austral University Hospital, Buenos Aires, Buenos Aires, Argentina; Marco Materazzo, Department of Surgical Science, Tor Vergata University, Roma, Lazio, Italy; Giovanni Merola, General and laparoscopic surgery, San Giovanni di Dio - Hospital, Frattamaggiore, Naples, Italy; Karl Anton Miller, Diakonissen Private Hospital, Surgery, Salzburg, Salzburg, Austria; Aleksandr Neimark, Department of Surgery, Almazov National Medical Research Center, Saint-Petersburg, Russia, Russia; Stephen Ka-kei Ng, Department of Surgery, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China; Abdulellah Mohamedamin Niyaz, Center of Metabolic and Bariatric Surgery, Neuwerk Hospital, Moenchengladbach, North Rhein Westphalia, Germany; Taryel Isgender Omarov, I Surgical Disease Department, Azerbaijan Medical University, Baku, Baku, Azerbaijan; Mariano Palermo, Bariatric Surgery, University of Buenos Aires, Buenos Aires, Buenos Aires, Argentina; Guillermo Ponce de Leon-Ballesteros, Department of Surgery, Hospital Star Medica Morelia, Morelia, Michoacan, Mexico; Dimitri J Pournaras, Department of Metabolic and Bariatric Surgery, North Bristol NHS Trust, Bristol, Bristol, UK; Sjaak Pouwels, Department of Surgery, Marien Hospital, University Clinic of Ruhr University Bochum, Herne, Nordrhine Westphalia, Germany; Xingshun Qi, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China; Reynaldo Martins e Quinino, Department of Integrated Medicine, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; Ravi Rao, General and Bariatric Surgery, Perth Surgical & Bariatrics, Perth, Western Australia, Australia; Vittal Sree Rama Rao, North Midlands Institute of Metabolic and Bariatric Surgery, University Hospital of North Midlands, Stoke-on-Trent, North Staffordshire, United Kingdom; Karl Peter Rheinwalt, Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus Hospital Cologne, Cologne, Northrhine-Westphalia, Germany; Felipe Martin Bianco Rossi, Department of Metabolic and Bariatric Surgery, RR Medicos Cirurgioes, Santo Andre, SP, Brazil; Jaime Ruiz-Tovar, Obesity Unit, Garcilaso Clinic, Madrid, Madrid, Spain; Elena Ruiz-Ucar, Department of Metabolic, Bariatric and endocrine surgery, Fuenlabrada Universitary Hospital, Madrid, Madrid, Spain; Sukhvinder Singh Saggu, Department of Metabolic and Bariatric Surgery, CK Birla Hospital, New Delhi, Delhi, India; Elgun Samadov, General Surgery, Liv Bonadea Hospital, Baku, Aze, Azerbaijan; Cosimo Saviello, Department of General and Bariatric Surgery, University of Salerno, Battipaglia, Salerno, Italy; Romano Schneider, Department of Surgery, University Health Network, Toronto, Ontario, Canada; Roman Schumann, Anesthesiology, Critical Care and Perioperative Medicine, VA Boston HCS, Boston, MA, USA; Sarah Seyedyousefi, Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Isfahan, Iran; Shahab Shahabi Shahmiri, Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Hazrat Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Tehran, Iran; Yongpeng Shi, Department of Infectious Diseases, The First Affiliated Hospital of USTC, Department of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Rob Snoekx, Department of Bariatric Surgery, Bariatrisch Centrum Zuid-West Nederland, Bravis Hospital, Bergen-op-Zoom, Noord-Brabant, The Netherlands; Xavier Sousa, General Surgery, Hospital Prof Doutor Fernando Fonseca, Lisboa, Lisboa, Portugal; Dan-Qin Sun, Department of Nephrology, Jiangnan University Medical Center, Wuxi, Jiangsu, China; Kon Voi Tay, Upper GI, Bariatric and Metabolic Surgery, General Surgery Department, Woodlands Health, Singapore, Singapore, Singapore; Salvatore Tolone, Division of General, Mininvasive, Oncological and Bariatric Surgery, University of Campania Luigi Vanvitelli, Naples, Campania, Italy; Zaher Toumi, Department of Bariatric Surgery, Spire Washington Hospital, Washington, Tyne & Wear, UK; Suthep Udomsawaengsup, Treatment of Obesity and Metabolic Disease Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand; Ala Wafa, Bariatric Surgery, Misurata University, Misurata, Tripoli, Libya; Ningjian Wang, Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, Shanghai, China; Ke Wang, Department of Infectious Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Zhuoqi Wei, Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Gaungdong, China; Thejana Kamil Wijeratne, Department of Surgery, University of Sri Jayewardenepura, Nugegoda, Western, Sri lanka; Mingfeng Xia, Endocrinology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China; Pengfei Xu, Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, Hubei, China; Liang Xu, Department of Hepatology, The Second People Hospital of Tianjin Medical University, Tianjin, Tianjin, China; Baowen Yuan, State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China; Roxanna Zakeri; Department of Upper Gastrointestinal Surgery, University College London Hospital, London, London, United Kingdom; Carlos Zerrweck, Bariatric Surgery Department, The American British Cowdray Medical Center, Mexico City, Mexico City, Mexico; Jinshan Zhang, Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China; Wen Zhang, Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Le Zhang, Department of Paediatrics, Affiliated Children's Hospital of Jiangnan University(Wuxi Children's Hospital), Wuxi, Jiangsu, China; Xiao-Dong Zhou, Department of Cardiovascular Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Mauricio Zuluaga Zuluaga, General and Bariatric and Metabolic Surgery, universidad del valle / hospital universitario del valle, cali Colombia, Cali, Valle del Cauca, Colombia.
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K.A., M.-H.Z. and W.Y. wrote the main manuscript text and K.A. prepared figures A-C. All authors reviewed the manuscript.
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Ming-Hua Zheng: Received honoraria for lectures from AstraZeneca, Hisky Medical Technologies and Novo Nordisk, consulting fees from Boehringer Ingelheim. Carel W le Roux: Reports grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board. He serves on advisory boards and speakers panels of Novo Nordisk, Roche, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Glia, Irish Life Health, Boehringer Ingelheim, Currax, Zealand Pharma, Keyron, AstraZeneca, and Rhythm Pharma. ClR is a member of the Irish Society for Nutrition and Metabolism outside the area of work commented on here. ClR provides obesity clinical care in the My Best Weight clinic and Beyond BMI clinic and is a shareholder in these clinics. Yusuf Yilmaz: Consultant for Zydus Therapeutics. Luca Valenti: Speaking: Viatris, Novo Nordisk, GSK; Consulting: Novo Nordisk, Pfizer, Boehringer Ingelheim, Resalis, MSD; Unrestricted grant support: Gilead. Dimitri J. Pournaras: Funded by the Royal College of Surgeons of England. He receives consulting fees from Johnson & Johnson and Novo Nordisk and payments for lectures, presentations, and educational events from Johnson & Johnson, Medtronic, and Novo Nordisk. Anna Carolina Hoff: Consultant for Boston Scientific. All other authors report no conflict of interest.
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Au, K., Zheng, MH., Lee, WJ. et al. Resmetirom and Metabolic Dysfunction-Associated Steatohepatitis: Perspectives on Multidisciplinary Management from Global Healthcare Professionals. Curr Obes Rep (2024). https://doi.org/10.1007/s13679-024-00582-z
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DOI: https://doi.org/10.1007/s13679-024-00582-z